cardiology Flashcards
(41 cards)
1
Q
acyanotic CHD
A
- ventricular septal defects (VSD)
- atrial septal defect (ASD)
- patent ductus arteriosus (PDA)
- coarctation of the aorta
- aortic valve stenosis
2
Q
cyanotic CHD
A
- tetralogy of Fallot
- transposition of the great arteries (TGA)
- tricuspid atresia
3
Q
Aortic stenosis
-pathophysiology
A
- narrow aortic valve that restricts blood flow from the left ventricle into the aorta
- severity varies and determines symptoms
- aortic valve has 3 leaflets - patients with AS may have 1,2,3 or 4 leaflets
4
Q
Aortic stenosis
- presentation
A
- mild AS may be asymptomatic and discovered as an incidental murmur
- more significant AS - fatige, SOB, dizziness and fainting
- symptoms worse on exertion as outflow from LV can’t keep up with demand
- severe AS - presents with HF within months of birth
5
Q
Aortic stenosis
- signs
A
murmur:
- Ejection systolic murmur - loudest on aortic area
- crescendo-decrescendo
- radiates to carotids
other signs:
- ejection click, just before the murmur
- palpable thrill during systole
- slow rising pulse and narrow pulse pressure
6
Q
Aortic stenosis
- Ix
- Mx
A
investigation for diagnosis = echocardiogram
- congenital AS tends to be progressive and worsen over time
- regular follow-up under a paediatric cardiologist
- more significant stenosis - may need to restrict physical activities
- options for treatment:
- precutaneous balloon aortic valvoplasty
- surgical aortic valvotomy
- valve replacement
7
Q
Aortic stenosis
- complications
A
- left ventricular outflow tract obstruction
- heart failure
- ventricular arrhythmia
- bacterial endocarditis
- sudden death, often on exertion
8
Q
pulmonary stenosis
- pathophysiology
A
- pulmonary valve consists of three leaflets
- leaflets can develop abnormally, becoming thickened or fused
- results in a narrow opening between the right ventricle and the pulmonary artery
- congenital pulmonary valve stenosis
9
Q
pulmonary stenosis
- associations
A
- tetralogy of fallot
- William syndrome
- noonan syndrome
- congenital rubella syndrome
10
Q
pulmonary stenosis
- presentation
A
- often completely asymptomatic and discovered as incidental finding of a murmur during routine baby checks
- more significant PS can present with symptoms of fatigue on exertion, shortness of breath, dizziness and fainting
11
Q
pulmonary stenosis
- signs
A
- ejection systolic murmur heard loudest at the pulmonary area
- palpable thrill in the pulmonary area
- right ventricular heave due to right ventricular hypertrophy
- raised JVP with giant a waves
12
Q
pulmonary stenosis
- Ix
- Mx
A
- gold standard investigation = echocardiogram
- mild without symptoms - no interventions, watching and waiting approach
- symptomatic or valve is more significantly stenosed - balloon valvuloplasty via a venous catheter
13
Q
ASD
- pathophysiology
A
- ASD is a defect in the septum between the two atria
- during development the two atria are connected
- septum primum and secundum grow acress the gap between the atria and eventually fuse with endocardial cushion to separate the two atria
- foramen ovale = small hole in septum secundum - usually closes at birth
- defects in septum primum or secundum lead to an atrial septal defect
14
Q
Eisenmenger syndrome
- pathophysiology
A
→ increased flow to right side of the heart leads to right-sided overload, increased pulmonary pressure and right heart strain
→ eventually causes pulmonary hypertension and right heart failure
- when pulmonary pressure exceeds systemic pressure, blood flows from right to left
- blood bypasses lungs and patient becomes cyanotic
15
Q
ASD types
A
- patent foramen ovale
- sinus venosus
- unroofed coronary sinus
- ostium secundum - septum secundum fails to fully close
- ostium primum - septum primum fails to close (tends to lead to AVSD)
16
Q
ASD
- complications
A
- stroke due to embolus from DVT crossing into left side of heart and to brain
- atrial fibrillation or atrial flutter
- pulmonary hypertension and right-sided heart failure
- eisenmenger syndrome
17
Q
ASD
- presentation
A
- may be detected on antenatal scan or NIPE
- may be asymptomatic in childhood and present in adulthood with dyspnoea, heart failure or stroke
- typical symptoms in childhood:
- SOB
- difficulty feeding
- poor weight gain
- lower respiratory tract infections
18
Q
ASD
- signs
A
- mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border
- fixed split second sound - pulmonary valve closes later than aortic valve
19
Q
ASD
- Ix
- Mx
A
- echocardiogram to confirm diagnosis
- managed by paediatric cardiologist
- management options include:
- active monitoring (small defects may close on their own)
- percutaneous transvenous catheter closure (via femoral vein)
- open-heart surgery
20
Q
VSD
- pathophysiology
A
- congenital hole in the septum between the left and right ventricles
- may be small or large affecting the whole septum
- left to right shunt
21
Q
VSD
- types
A
- outlet - below semilunar valves
- inlet - below AV valves
- perimembranous - close to membranous septum
- muscular - in muscular part of septum
22
Q
VSD
- associations
A
- Down’s syndrome (AVSD)
- Turner’s syndrome
23
Q
VSD
- presentation
A
- often initially symptomless and patients can present in adulthood
- may be detected during antenatal scans or newborn check
- symptoms:
- poor feeding
- dyspnoea
- tachypnoea
- failure to thrive
24
Q
VSD
- signs
A
- pan-systolic murmur heard loudest at left lower sternal border in third and fourth intercostal spaces
- may be a systolic thrill on palpation
25
VSD
- Ix
- Mx
- echo to confirm diagnosis
- management options include:
- active monitoring
- percutaneous transvenous catheter closure
- open-heart surgery
VSD increases risk of infective endocarditis
26
tetralogy of fallot
- 4 componenets
- ventricular septal defect
- overriding aorta
- pulmonary valve stenosis
- right ventricular hypertrophy
27
TOF
- patho
→ the VSD allows blood to flow between the ventricles
→ overriding aorta means the entrance to the aorta is further to the right, above the VSD - means more deoxygenated blood from the right side enters the aorta
→ pulmonary valve stenosis give more resistance against blood from right ventricle - encourages blood through the VSD and into the aorta rather than to the pulmonary vessels
- overriding aorta and pulmonary stenosis allow blood shunting right to left → cyanosis
→ increased strain on muscular wall of the right ventricle causes right ventricular hypertrophy
→ degree of cyanosis is mostly related to the severity of the pulmonary stenosis
28
TOF
- RF
- rubella infection
- increased age of the mother (over 40)
- alcohol consumption in pregnancy
- diabetic mother
29
TOF
- Ix
- echocardiogram - doppler flow studies
- chest x-ray may show “boot shape” due to right ventricular thickening
30
TOF
- presentation
- mostly picked up on antenatal scans
- ejections systolic murmur caused by pulmonary stenosis on newborn baby check
- severe cases - present as heart failure before one year
- milder cases - present as older children once they develop signs and symptoms of heart failure
31
TOF
- S&Sx
- cyanosis
- clubbing
- poor feeding
- poor weight gain
- ejection systolic murmur loudest in pulmonary area
- “tet spells”
32
Tet spells
- patho
- causes
- presentation
- exercise -> generate lots of CO2
- vasodilator -> causes systemic vasodilation
- systemic vascular resistance reduces
- blood goes from RV to aorta rather than pulmonary vessels, bypasses lungs
cause:
- walking
- physical exertion
- crying
- child will become irritable, cyanotic and short of breath
- severe spells can lead to reduced consciousness, seizures and death
33
Tet spells
- Mx
- knees to chest
- O2
- Beta blockers
- IV fluids
- morphine
- sodium bicarb
- phenylephrine infusion
34
TOF
- Mx
- neonates -> prostoglandin infusion to maintain ductus arteriosus
- surgical repair definitive treatment
35
transposition of the great arteries
- patho
- the attachments of the pulmonary trunk and aorta are swapped
- right ventricle pumps blood into the aorta and left ventricle pumps blood into the pulmonary vessels
- two separate circulations that don’t mix - one travels through systemic system and right side of heart and the other through the pulmonary system and left side
36
TGA
- associations
- VSD
- coarctation of the aorta
- pulmonary stenosis
37
TGA
- presentation
- often diagnosed on antenatal scans
- when not detected during pregnancy - presents with cyanosis at or within a few days of birth
- a PDA or VSD can initially compensate by allowing blood to mix
38
TGA
- Mx
- where there’s a VSD, allows time for definitive treatment
- prostaglandin infusion can be used to maintain the ductus arteriosus
- balloon septostomy - inserting catheter into foramen ovale via umbilicus, and inflating to create a large ASD
- open heart surgery is definitive - cardiopulmonary bypass machine is used to perform an arterial switch within a few days of birth
39
patent ductus arteriosus
- patho
- connection between the pulmonary trunk and descending aorta
- usually, the ductus arteriosus closes with the first breaths
- more common in premature babies
40
PDA
- features
- left subclavicular thrill
- continuous 'machinery' murmur
- large volume, bounding, collapsing pulse
- wide pulse pressure
- heaving apex beat
41
PDA
- Mx
preterm:
- initial expectant supportive care -> spontaneous closure often occurs
- if hemodynamically significant ΡDA remains or the infant remains ventilator dependent after one week:
-> ibuprofen, indomethacin or paracetamol
term:
- transcatheter PDA closure
